Prevalence and prognostic value of Delirium as the initial presentation of COVID-19 in the elderly with dementia: An Italian retrospective study

Tino Emanuele Poloni, Arenn Faye Carlos, Marco Cairati, Chiara Cutaia, Valentina Medici, Eleonora Marelli, Danila Ferrari, Alberto Galli, Paola Bognetti, Annalisa Davin, Alice Cirrincione, Arcangelo Ceretti, Cristina Cereda, Mauro Ceroni, Livio Tronconi, Silvia Vitali, Antonio Guaita

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Delirium may be one of the presenting symptoms of COVID-19, complicating diagnosis and care of elderly patients with dementia. We aim to identify the prevalence and prognostic significance of delirium as the sole onset manifestation of COVID-19.

Methods: This is a retrospective single-centre study based on review of medical charts, conducted during the outbreak peak (March 27-April 18, 2020) in a Lombard dementia facility, including 59 elderly subjects with dementia and laboratory-confirmed COVID-19.

Findings: Of the 59 residents, 57 (96⋅6%) tested positive (mean age: 82⋅8; women: 66⋅7%). Comorbidities were present in all participants, with 18/57 (31⋅6%) having three or more concomitant diseases. Delirium-Onset COVID-19 (DOC) was observed in 21/57 (36⋅8%) subjects who were chiefly older (mean age: 85⋅4 y/o) and with multiple comorbidities. Eleven/21 DOC patients (52⋅4%) had hypoactive delirium, while hyperactive delirium occurred in ten/21 (47⋅6%). Lymphopenia was present in almost all subjects (median: 1⋅3 × 109/L). Overall mortality rate was 24⋅6% (14/57) and dementia severity per se had no impact on short-term mortality due to COVID-19. DOC was strongly associated with higher mortality (p<0⋅001). Also, DOC and male gender were independently associated with increased risk of mortality (OR: 17⋅0, 95% CI: 2⋅8-102⋅7, p = 0⋅002 and 13⋅6, 95% CI: 2⋅3-79⋅2, p = 0⋅001 respectively).

Interpretation: Delirium occurrence in the elderly with dementia may represent a prodromal phase of COVID-19, and thus deserves special attention, especially in the presence of lymphopenia. Hypoxia and a severe inflammatory state may develop subsequently. DOC cases have higher short-term mortality rate.

Funding: None.

Original languageEnglish
Pages (from-to)100490
JournalEClinicalMedicine
DOIs
Publication statusE-pub ahead of print - Jul 30 2020

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